Maria Fowler 1
By Robyn L. Golden and Matthew R. Vail
￼Nearly one in five older adults in America has at least one identified mental health concern (Centers for Disease Control and Prevention and National Association of Chronic Disease Directors, 2008; Eden et al., 2012). Some of the most common disorders diagnosed among this population include depression, anxiety, and cognitive impairment. Depression alone affects more than 6.5 million of the 35 million Americans older than age 65 (Centers for Disease Control and Prevention and National Association of Chronic Disease Directors, 2008). Given that the number of adults older than age 65 is projected to surge from 40.3 million in 2010 to 72.1 million by 2030, the incidence of mental health diagnosis among older adults will have profound implications for the mental health system (Eden et al., 2012).
The mental health needs of older adults long have been neglected in the United States. The healthcare workforce is largely unprepared, in numbers and expertise, to confront the specific mental health needs of our aging population (Eden et al., 2012). Even clinicians lacking training in geriatrics have been unable to provide adequate mental health services to our aging population due to a long history of disparity in insurance coverage for physical and mental health treatments. The Affordable Care Act (ACA), though not a panacea, provides an opportunity to bolster a broken mental health system that disproportionately ignores the needs of older adults.
Expanding Insurance Coverage
The ACA includes a variety of provisions to effect the biggest expansion of mental health and substance abuse services in a generation. The first is the proliferation of health insurance coverage through the Health Insurance Exchanges (HIE) and state-specific Medicaid expansions, which will dramatically expand coverage for those not eligible for Medicare. Early estimates indicated that the overall rate of uninsured residents in the United States would drop by nearly 50 percent following full implementation of the ACA (Kenney et al., 2013). Given the high level of controversy around the interpretation of enrollment numbers following the close of the ACA’s first enrollment period, it is too soon to determine the accuracy of such assessments. However, White House estimates of 8 million enrollees in HIEs and 3 million in Medicaid expansion programs indicate that the ACA already has had a profound effect on national coverage rates (Holst, 2014). The U.S. Department of Health and Human Services estimates that more than 2 million of the new HIE enrollees are older than age 55 (ASPE Office of Health Policy, 2014).
In addition to expanding avenues for obtaining affordable healthcare coverage, the ACA also prohibits insurance companies from denying coverage to people with pre-existing conditions. This change will benefit many people who were previously locked out of the private market, including those who had been excluded because o...